Genitourinary plastic surgery

Genitourinary plastic surgery, often referred to as genitourinary reconstruction, is a specialized field of urology and plastic surgery dedicated to restoring the form and function of the urinary and genital organs. This field addresses everything from traumatic injuries and congenital defects to gender-affirming care and cosmetic rejuvenation.

1. What is it? Any common name for this procedure?

These procedures involve the surgical repair, restoration, or aesthetic enhancement of the male and female reproductive systems and urinary tracts.

• Common Names: Genitourinary (GU) Reconstruction, Reconstructive Urology, Genital Plastic Surgery, or Uro-plastic surgery.
• Common Procedures:
  • Urethroplasty: Rebuilding the urethra to treat scar tissue or blockages (strictures).
  • Phalloplasty & Vaginoplasty: Construction or reconstruction of the penis or vagina, often for gender affirmation or trauma.
  • Penile Prosthetics: Implantation of devices to treat erectile dysfunction.
  • Vaginal Rejuvenation/Labiaplasty: Cosmetic or functional reshaping of the female genitalia.
  • Hypospadias Repair: Correcting a congenital condition where the urethral opening is not at the tip of the penis.

2. Common Symptoms for Medical Consultation

Consult a urologist or reconstructive plastic surgeon if you experience functional or structural issues in the pelvic region:

• Voiding Dysfunction: Difficulty urinating, weak stream, or inability to empty the bladder.
• Hematuria: Presence of blood in the urine.
• Genital Pain or Bruising: Specifically after trauma or injury to the groin or scrotum.
• Structural Abnormalities: Visible bends in the penis (Peyronie's disease) or congenital malformations.
• Incontinence: Accidental leakage of urine or sudden, uncontrollable urges.
• Sexual Dysfunction: Inability to achieve an erection or pain during intercourse.

3. List of Associated Diseases

Genitourinary plastic surgery is the primary treatment for various pathological and traumatic conditions:

• Urethral Stricture Disease: Narrowing of the urethra due to scar tissue from injury or infection.
• Genitourinary Trauma: Injuries to the kidneys, bladder, penis, or scrotum from accidents or sports.
• Peyronie’s Disease: Fibrous scar tissue that develops inside the penis, causing curved, painful erections.
• Pelvic Organ Prolapse: When pelvic organs (like the bladder) drop from their normal position.
• Vesicovaginal or Bladder Fistulas: Abnormal openings between the bladder and other organs (like the vagina).
• Gender Dysphoria: Where genital surgery is required for alignment with gender identity.

4. List of Screening Tests for This Procedure

Before surgery, clinicians use specialized imaging and functional tests to map the internal anatomy:

• Retrograde Urethrogram (RUG): An X-ray with contrast fluid to identify the location of urethral blockages.
• Cystoscopy: Using a camera-equipped tube to look directly inside the urethra and bladder.
• Voiding Cystourethrogram (VCUG): An X-ray that shows how the bladder empties in real-time.
• Testicular Ultrasound: To evaluate damage to the scrotum or testicles after trauma.
• Urodynamic Testing: To measure how well the bladder and urethra store and release urine.

5. Am I Eligible for This Procedure?

• Medical Necessity: Most patients are eligible if the procedure restores bodily function, enhances health, or significantly improves quality of life.
• Stable Weight: Especially for cosmetic or gender-affirming procedures, a stable weight is preferred for optimal results.
• Infection-Free: You must be free of active urinary tract infections (UTIs) at the time of surgery.
• Psychological Readiness: For gender-affirming surgeries, a multidisciplinary evaluation is standard to ensure alignment with long-term goals.

6. Pre and Post Care for This Procedure

Pre-Care:

• Smoking/Alcohol Cessation: Stop at least 3 weeks before surgery to ensure proper blood flow and healing.
• Medication Audit: Avoid aspirin or other blood thinners as directed to minimize bleeding risks.
• Hydration and Nutrition: Prioritize protein and water intake in the weeks leading up to the procedure.

Post-Care:

• Catheter Management: Many patients will use a urinary catheter for 2 to 4 weeks while the internal tissues heal.
• Activity Restrictions: Avoid driving, heavy lifting, or sitting for long periods for the first 2 to 3 weeks.
• Sexual Abstinence: Typically required for at least 6 weeks post-surgery.
• Hygiene: Keep the surgical area clean and dry; your provider may recommend specific antibiotic ointments or sitz baths.

7. Days Required for Hospitalization

The length of stay varies significantly based on the complexity of the reconstruction.

Disclaimer: As per doctor’s advise, the number of days for hospitalization may get modified based on individual healing rates, the use of robotic-assisted techniques, and the presence of any underlying medical conditions.

8. Benefits of This Procedure

• Restoration of Normal Anatomy: Corrects deformities caused by birth, cancer, or trauma.
• Improved Urinary Function: Eliminates the need for long-term catheters and resolves chronic voiding issues.
• Independence: Restores the ability to void naturally and maintain continence.
• Psychological Well-being: For gender-affirming care, these procedures can significantly reduce gender dysphoria and improve mental health.

Enhanced Quality of Life: Restores sexual function and physical comfort, allowing for a return to regular activities and social confidence.